Nishikawa Yuko, Oku Hidehiro, Tonari Masahiro, Matsuo Junko, Sugasawa Jun, Ikeda Tsunehiko
Department of Ophthalmology, Osaka Medical College, Takatsuki, Osaka, Japan,
Clin Ophthalmol. 2018 Jun 26;12:1149-1153. doi: 10.2147/OPTH.S164306. eCollection 2018.
Idiopathic orbital inflammation (IOI) and orbital cellulitis can present similar clinical features, and the diagnoses of these two disorders are sometimes confused. The purpose of the present study was to determine whether or not inflammatory markers in the blood can be useful to differentiate between IOI and orbital cellulitis in cases with acute eyelid erythema and edema.
In this retrospective single-institute study, we reviewed the medical records spanning the past 10 years at the Department of Ophthalmology, Osaka Medical College Hospital, Takatsuki, Osaka, Japan, and found 45 cases, with patients >15 years of age, with presumed IOI. Their blood samples were obtained within 5 days after the onset of IOI. Of those cases, 15 patients (10 males, 5 females, mean age of 56.9 years; range 38-76 years) presented acute eyelid erythema and edema, and were initially misdiagnosed as orbital cellulitis. Thus, inflammatory markers in the blood (ie, white blood cells [WBCs] and C-reactive protein [CRP]) of those 15 patients were analyzed with 17 patients (10 males, 7 females) having orbital cellulitis. The receiver operating characteristic curve analysis was performed to determine the optimal cut-off values.
The mean ± standard error (SE) levels of the WBC were 6.80±0.70×10/μL in the IOI patients, and 8.54±0.91×10/μL in the orbital cellulitis patients, and no significant differences were observed (=0.15, Student's -test). However, the mean ± SE levels of CRP were 1.04±0.43 mg/dL in the IOI patients, yet were significantly increased to 4.65±1.21 mg/dL in the orbital cellulitis patients (=0.01, Student's -test). The area under the curve value was 0.80 and the optimal cut-off value was 0.43 for orbital cellulitis, with sensitivity and specificity being 82% and 73%, respectively.
The findings of this study indicate that CRP may be useful in distinguishing patients with idiopathic orbital inflammation from those with orbital cellulitis.
特发性眼眶炎症（IOI）和眼眶蜂窝织炎可表现出相似的临床特征，这两种疾病的诊断有时会相互混淆。本研究的目的是确定血液中的炎症标志物是否有助于鉴别急性眼睑红斑和水肿患者的IOI和眼眶蜂窝织炎。
在这项单机构回顾性研究中，我们回顾了日本大阪高槻市大阪医科大学医院眼科过去10年的病历，发现45例年龄大于15岁、疑似IOI的患者。在IOI发病后5天内采集他们的血液样本。在这些病例中，15例患者（10例男性，5例女性，平均年龄56.9岁；范围38 - 76岁）出现急性眼睑红斑和水肿，最初被误诊为眼眶蜂窝织炎。因此，对这15例患者的血液炎症标志物（即白细胞[WBC]和C反应蛋白[CRP]）与17例眼眶蜂窝织炎患者（10例男性，7例女性）进行了分析。采用受试者工作特征曲线分析来确定最佳临界值。
IOI患者白细胞的平均±标准误（SE）水平为6.80±0.70×10⁹/μL，眼眶蜂窝织炎患者为8.54±0.91×10⁹/μL，未观察到显著差异（P = 0.15，Student's t检验）。然而，IOI患者CRP的平均±SE水平为1.04±0.43mg/dL，而眼眶蜂窝织炎患者显著升高至4.65±1.21mg/dL（P = 0.01，Student's t检验）。眼眶蜂窝织炎的曲线下面积值为0.80，最佳临界值为0.43，敏感性和特异性分别为82%和73%。
本研究结果表明，CRP可能有助于区分特发性眼眶炎症患者和眼眶蜂窝织炎患者。
